Doctors can see more patients and provide better quality care with better outcomes and greater satisfaction on both sides if they follow a team care model. That's the message that family practitioner Peter Anderson is spreading to any doctors who will listen.

In 2003, after two decades as a family practitioner in Newport News, Anderson had hit bottom.

"I pretty much hated medicine. I was too old to change professions. I had my back to the wall, it was bleak," said the University of Virginia-trained physician, now 60.

His distress was caused by patient overload, diminishing reimbursements, and longer working hours. These issues are not particular to Anderson as the medical profession wrestles with an aging population, millions living longer with chronic illnesses, and cuts in health spending. Anderson describes it as "a perfect storm" brewing over the next decade, particularly in primary care which fewer and fewer doctors are choosing.

After 12 years in independent practice, Anderson joined Riverside in 1994. Almost a decade later, he told administrators, "There's nothing that's working." The switch to electronic medical records in 1998 precipitated the problem, resulting in a 35 percent drop in Anderson's productivity. "I type at six words a minute," he volunteered. "The benefits of having all that data were dramatically negated by time."

He and his patients were equally frustrated by lack of access, he was working all the time, and he rarely got to see his family.

Something had to change.

Cathi Pope, his long-time nurse, provided the catalyst when she asked for a raise and gave in her notice. He surprised her by asking her to give him six months, Pope, a 27-year employee, recalled.

Anderson duly developed and implemented the state's first patient medical home recognized by the National Committee on Quality Assurance. The heart of the system relies on a team-based approach in which nurses, doctors (providers), and support staff work to the capacity of their training. In making the change — including hiring more trained staff — Anderson turned his life and practice around. His work week dropped from 70-plus hours to 45, he saw up to 40 patients daily — 17 more than previously — and patient satisfaction and quality measures "went through the roof." And the practice turned a profit again.

In 2005, at the urging of his wife, Laurie, a registered nurse, Anderson wrote a handbook, "Liberating the Family Physician," to walk primary care providers through the process. Now, with his consulting company, Team Care Medicine, Anderson trains others in how to deliver care both more efficiently and effectively and with greater satisfaction for both patients and providers. Though it's primarily geared to primary care physicians, he believes the model is applicable to most specialties.

Eighteen months ago, Anderson landed a $1 million contract with the Army to train primary care providers at 21 new clinics. In January 2012, he moved into full-time consulting, taking on commercial customers. Some of his staff, including Pope, followed him. "He's a visionary. He's always looking for the best way to deliver care," she said. To date Team Care has trained about 200 doctor-nurse teams. "It has been fun, though I miss the patients," Anderson said.

Team Care Medicine training

On Wednesday, Team Care Medicine provided a free one-day training in the medical home model to staff and administrators from several of the Peninsula's free clinics. Using a tag-team approach, Anderson and Ron Chapman, a professional trainer, presented the essential elements of the patient home model.

They ran through the four elements of a clinical visit, starting with data gathering, then analysis of the data and the physical exam, followed by decision-making and the development of a plan, and finally implementation of the plan and patient education.

The key is in staffing and having staff fill appropriate roles, explained Anderson. The ideal set-up is for a doctor/provider to have three trained TCAs (team care assistants), who might be medical assistants, registered nurses, or licensed practical nurses, along with appropriate support staff. He assured that though it sounds counterintuitive to hire more staff when trying to cut costs, the investment is rewarded quickly. According to Chapman, doctors see a 100 percent return within six months. Just seeing two more patients a day pays for one TCA, he said. And, using this model, practices can expect to see between 30 and 80 percent more patients. The model can also work for a provider with two TCAs and support staff.

With more staff involved in a visit, the division of labor changes, freeing up the doctor to focus exclusively on the patient. "I went to medical school, this allowed me to use my education effectively," said Anderson. And, despite a doctor's contact with a patient being reduced from about 30 minutes to 10, a patient's perception is that they've received more time according to patient satisfaction surveys, said Chapman. Nurses do the time-consuming work of obtaining and recording patient histories, then deliver the key information in just 1 to 1 1/2 minutes to the doctor in the room with the patient. Anderson emphasizes the importance of the latter protocol. "I'm stunned by how many providers collect data outside the room," he said. The doctor then refines and fills in any information for the final report on the patient.

Another change involves the nurse staying in the room throughout the visit, taking the preliminary information, observing and recording the diagnosis and treatment, and closing out the visit with instructions and patient education. "It takes the administrative burden off the doctor. It improves the quality because doctors aren't as rushed. Being more relaxed gives them better insight into a patient's needs," said Chapman.

Nurses like the system too, Pope assures. "I like it. First, there's co-workers. It's like a dance, getting the rooms ready. Ideally, he's walking directly from one room to the next. It's more of a team environment with layering. You see the whole process, not just one part of it." She added that the notes are more complete in the records, which allows nurses to help those who call in more effectively. "An electronic medical record used correctly is perfect," she said.

Attendee Ralph Robertson, medical director of the Lackey Clinic in Yorktown, found the presentation encouraging. "I've been enthused about it all along, but concerned about how to fit it into a system with our multiple volunteers," he said. "This is a quantum leap kind of thing. It's all or nothing." He thought it could possibly be implemented by adjusting the role of nurses in the team and using scribes as assistants. Pre-med student Myung Bae, a scribe at Lackey and Mary Immaculate Hospital, also thought it could work at the clinic. "Without the billing and liability issues there, we could make all the documentation," he said.

For Jeff Black, program manager at Angels of Mercy Medical Clinic in Norge, the presentation prompted him to rethink the role of its volunteer pre-med students from the College of William and Mary and how they could help reduce the burden on providers. "We can get them more involved in patient data," he said. "We need to redesign health care to a team-based model in this country. It's the only answer."

For some, technology is an impediment. Jackie Galloway, a physician with Newport News Pediatrics, affiliated with Children's Hospital of the King's Daughters, is working on adapting Anderson's handbook for pediatricians. However, a fix to CHKD's electronic medical records is necessary before she can implement the model in her own practice; currently, their design separates nurses' notes from physicians' notes. That needs to change to accommodate the staff's overlapping roles in the data-driven patient medical home model.

Want to know more?

Team Care Medicine, founded in 2003 by Dr. Peter Anderson, offers a team-care model for delivering health care that enables physicians to spend more time with patients and delivers better quality of care. Contact Team Care at 757-650-5603 or familyteamcare@gmail.com, or find them on the web at http://www.familyteamcare.org.